If you are an Insurance Broker or Agent and not already
registered with us, please fill out the application form below
and hit 'Submit'.

Permanent registration is subject to approval from SportUnderwriters.com.
Please note that eligibility for our Broker/Agent program requires the applicant to hold a valid
Agent or Broker license and a valid Error and Omissions policy.

As soon as you're registered, we will email you an Agent/Broker ID number along with information on how to access
the site using that number.

Please specify the insurance license number for each State in which you are licensed to sell/broker insurance. (Leave blank, or indicate with N/A, the entry for any State in which you are not currently licensed)

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District Of Columbia

Federated States Of Micronesia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Marshall Islands

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Palau

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virgin Islands

Virginia

Washington

West Virginia

Wisconsin

Wyoming

(*'d fields are mandatory)

I am an Authorized Representative and/or an Officer of the licensed Brokerage.
In addition, I confirm and warrant that the licenses described above are in good standing.
I further confirm and warrant that the E&O policy described above is in full force and effect.